Directed Teaching of Clinical Reasoning in the Fourth Year of Medical School: A Structured Summary of Genetic Observations

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Published May 1, 2025
https://doi.org/10.62438/tunismed.v103i5.5615
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Vol. 103 No. 5 (2025): Tunis Med May 2025

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Houweyda Jilani
Genetic department, Mongi Slim hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis,Tunisia
Sonia Mazigh
Pediatric department C, Bechir Hamza Children’s hospital. Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
Yasmina Elaribi
Genetic department, Mongi Slim hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis,Tunisia
Lamia Ben Jemaa
Genetic department, Research Laboratory LR22SP01, Mongi Slim hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis,Tunisia

Abstract

Introduction: Clinical reasoning (CR) encompasses diagnostic activity, treatment planning, execution, and monitoring, as well as prognosis establishment. It is a skill that needs to be taught rather than left to chance. Clinical rotations provide an ideal learning environment for CR.


Aim: To evaluate a directed teaching (DT) approach for CR learning, using structured summary of observation (SSO), based on a known case during a genetics rotation for fourth-year medical students (MS4).


Methods: This was a longitudinal, descriptive study involving MS4 on a genetics rotation during the first semester of the 2020/2021 academic year. Three DT sessions were conducted, focusing on the development of SSOs to teach Down syndrome, Turner syndrome, DiGeorge syndrome, and fragile X syndrome. The pedagogical approach was evaluated based on the grades assigned to the SSOs, a comparison of pre- and post-test averages, calculation of the relative gain for the average grades of the three DT sessions, calculation of the Cohen's d effect size, and calculation of the heterogeneity rate. Student evaluation of the teaching approach was done through a satisfaction questionnaire.


Results: Forty-nine students divided into 10 groups of four to six students participated in three DT sessions. The average grade for the SSOs was 14.12 [10.75-16.5] (p=0.15). The average grade for the pre-tests was 9.3 [7.16-11.23] (p=0.13), and for the post-tests, it was 13.22 [11.93-14.59] (p=0.034). The relative gain for the average grades of the three DT sessions was 35.81% [10.9-65.78]. The heterogeneity rate was 21.98% for the pre-test averages ...(abstract truncated at 250 words).

Keywords:

Teaching, learning, clinical reasoning, clinical case, clinical training rotation, genetics

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Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Author Biography

Houweyda Jilani, Genetic department, Mongi Slim hospital, La Marsa. Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis,Tunisia

genetique la marsa

References

  1. Bernard JL, Reyes P. Apprendre en médecine (1re partie). Pédagogie médicale. 2001;2(3):163-9.
  2. Locke J. Essai sur l'entendement humain. Paris : Vrin ; 1693.
  3. Mazur E. Farewell, lecture? Science. 2009;2(5910):50–1.
  4. Krathwohl DR. A revision of Bloom’s taxonomy: An overview. Theorypract. 2002;41(4):212–8.
  5. Divaris K, Barlow PJ, Chendea SA, Cheong WS, Dounis A, Dragan IF et al. The academic environment: the students’ perspective. Eur J Dent Educ. 2008;12Suppl 1:S120–S30.
  6. Tabbane C. Eléments d’introduction aux ateliers de pédagogie médicale. Tunis: Centre de Publication Universitaire. 2000.
  7. Schmidt HG. A brief history of problem-based learning. In: O'Grady G, Yew EHJ, Goh KPL, Schmidt HG, dir. One-Day,One-Problem, An Approach to Problem-Based Learning. Singapore: Springer; 2012. p. 21–40.
  8. Likert R. A technique for the measurement of attitudes. Arch Psychology. 1932;22(140):1-55.
  9. Kirkpatrick DL, Kirkpatrick JD. Evaluating Training Programs: The Four Levels. 3rd edition. San Francisco: Berrett-Koehler ; 2006.
  10. Gérard FM, Braibant JM, Bouvy T. Évaluer l’efficacité pédagogique d’une formation ou d’un cours à l’aide d’un outil d’autoévaluation. Luxembourg : 19e Colloque de l’ADMEE-Europe ; 2006.
  11. Hattie J, Yates GC. Visible learning and the science of how we learn. New York : Routledge ; 2014.
  12. Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York :Routledge ; 1988.
  13. D’Hainaut L. Concepts et méthodes de la statistique. Bruxelles : Labor ; 1975.
  14. Ouellet G. Statistiques. Théorie, exemples, problèmes.Sainte-Foy : Le Griffon d’argile ; 1985.
  15. Fournier JP, Thiercelin D, Pulcini C, Alunni-Perret V, Gilbert E, Minguet JM, et al. Évaluation du raisonnement clinique en médecine d’urgence: les tests de concordance des scripts décèlent mieux l’expérience clinique que les questions à choix multiples à contexte riche. Pédagogie médicale. 2006;7(1):20-30.
  16. McGuire CH. A summary of the evidence regarding the technical characteristics of patient management problems. University of Illinois College of Medicine Report ; 1967.
  17. Higgs J, Jones M. Clinical reasoning in the health professions. In: Higgs J, Jones M dir. Clinical Reasoning in the Health Professions. 2nd edition. Oxford : Butterworth-Heineman Ltd ; 2000:3-14.
  18. Nendaz M, Charlin B, Leblanc V, Bordage G. Le raisonnement clinique : données issues de la recherche et implications pour l’enseignement. Pédagogie médicale. 2005;6:234-53.
  19. Pestiaux D, Vanwelde C. Le difficile enseignement de la démarche clinique. Santé, 2008;(46).
  20. Inra JA, Pelletier S, Kumar NL, Barnes EL, Shields HM. An active learning curriculum improves fellows' knowledge and faculty teaching skills. Adv Med EducPract. 2017;8:359-64.
  21. Piriou V, Molliex S, Tournadre JP, Llorca G, Chaumette F, Bastien, et al. Evaluation d’un enseignement magistral par simulateur d’anesthésie informatique en formation initiale des infirmiers anesthésistes. Pédagogie médicale. 2002;3(2):108-15.
  22. Llorca G. Évaluation de l’efficacité pédagogique immédiate de deux méthodes classiques en formation médicale continue. Pédagogie médicale. 2003;4(1):26-32.
  23. Yangui F, Charfi M, Abouda M, Ben Hmida E, Charfi MR. Evaluation d'une méthode d'enseignement interactif dans l'enseignement de la pneumologie. Tunis Med. 2018;96(05):259-63
  24. Hagui M, Ben Hamida E, Lassoued MB, Lamine K. L’apprentissage par résolution de problème en médecine d’urgence: intérêt et perception des apprenants. Tunis Med. 2019;97(11):1326-31.
  25. Guilbert JJ. Guide pédagogique pour les personnels de santé. Genève : Organisation Mondiale de la Santé; 1990.
  26. Kraoua L. Enseignement dirigé sur le conseil génétique en pathologies héréditaires et non héréditaires : Elaboration et évaluation [Mémoire]. Médecine : Tunis ; 2018. 27 p.
  27. Bourcier T, Laroche L. Comment optimiser une présentation assistée par ordinateur? Pédagogie médicale. 2005;6(2):123-4.
  28. Ploteau S, Winer N, Barrier J, Rogez JM, Philippe HJ. Évaluation des enseignements et des enseignants par les externes lors d'un stage clinique dans un service de gynécologie–obstétrique. J GynecolObstetBiolReprod. 2007;36(8):807-16.
  29. Romainville M, Coggi C. L'évaluation de l'enseignement par les étudiants : approches critiques et pratiques innovantes. Bruxelles : De Boeck ; 2009.
  30. Gelly J, Aubert JP, Cartier T, Le Bel J, Nougairede M. Evaluation de l’impact immédiat d’un dispositif pédagogique de formation hybride sur les connaissances des étudiants de second cycle en matière de prévention en soins primaires. Pédagogie médicale. 2011;12(3):149-58.
  31. Mehlman CT, Farmer JA. Teaching orthopaedics on the run: tell me the story backward. Clinical Orthopaedics and Related Research. 2003;(413):303-8